Social forces may limit health care reform

That’s not a universally shared view, though. The Heritage Foundation’s Ed Haislmaier is skeptical about whether government interventions can do much about disparities, especially since, he argues, so many of them come down to individual decisions on issues like what to eat and whether to exercise.

He also doubts that expanding coverage will have an impact because Medicaid’s low payments to doctors might make it hard for patients to actually get care.

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“There’s only so much that you can do through the public health system and even social engineering outside of health care,” Haislmaier said. “There’s this kind of presumption if we just had better circumstances, people would be better. I think that’s way overblown.”

But there are studies that suggest interventions in inequality outside of health care could not only save many lives but also take a huge bite out of health costs.

A review of mortality data by a team that included Adam Karpati, executive deputy commissioner of New York City’s health department, found that in 2000, 245,000 people without high school diplomas died who most likely would have lived if they had at least finished school. That is 52,000 more people than the number of those who died that year of a heart attack, which was then the leading cause of death.

Another study, led by the CDC’s Bobby Milstein, showed that behavioral and environmental interventions saved 4.5 million lives and $596 billion over a 25-year period. Providing universal health insurance coverage, by contrast, would save only 800,000 lives and increased health spending by $1.5 trillion.

Does that mean lawmakers who are looking for ways to slow health spending would be better off putting money in the Department of Education than HHS?

“I actually think the good news is those kinds of choices don’t have to be made,” said Angela Glover Blackwell, founder of PolicyLink, a think tank on inequality. If other departments embrace health priorities, she said, they can make policy that leverages their existing resources to improve health.

But that may not be so easy given that other departments have their own priorities and constituencies, as do their appropriators.

Asked about this challenge, Koh said the department is taking “a much more community-based approach” to working with city governments and nonprofits to align education, housing and food policies at the local level.

It is not entirely clear how much support the HHS initiatives have from the White House. Obama proposed cutting $3.5 billion of the Prevention and Public Health Fund in his September deficit-reduction proposal. The administration also agreed as part of an April budget deal to a $600 million funding cut for community health centers that serve a largely low-income population.

Marks also said these resources will need special protection as the supercommittee attempts to close a deal because they are believed to be possible sources of savings.

Social engineering and more money are not the answers. That's the easy way to buy a clear conscience, build more government, and ignore the cause of the problem. Education does not require more money. It requires hard work, and a dedication to actually improving the possibilities for the disadvantaged. A concerted effort to restore the responsibilities of the family would also be a huge help, and this does not require more money, either. There will NEVER be enough money to lift all people out of poverty. The very idea that things will solve this problem is sheer self-serving stupidity.

Just think about what this article says: Poor People Make Worse Life Choices Than Rich People.

If a Conservative or a Republican had said this the Marxist Democrats would be tar and feathering him right now in preparation for running him out of town on a rail.

Humbolt has it right, there will *NEVER* be enough money to lift everyone out of poverty. The Marxist Democrats have bee trying to do this for 50 years while spending us into ruin -- and poverty is higher now than when they started.

And Grace, if people persist in living where there is no health care then they *will* have life consequences equivalent to those in third world countries with no health care. 1) Who are you to criticize these people for their lifestyle choices and, 2) Who are you to blame everyone else for the lifestyle choices others make?

I grew up in a county with one doctor for the entire county. It was a rural county. It was more than 30 miles to the nearest, *SMALL* hospital and more than 70 miles to the nearest large, well equipped hospital. My folks were poor but they didn't make bad lifestyle choices even so. They lived where they thought the lifestyle contributed to bringing up children in a safe, nurturing environment. They asked for nothing from the government -- and they raised us up to be good citizens.

There is one thing that was brushed over in this article that I think is the single most important cause to the failure of blacks and other minorities, "people without a high school diploma are almost twice as likely to develop diabetes as those who have more than a high school education."

Uneducated people make uneducated decisions and this needs to be addressed because they are doing harm to themself and are a drain on the American taxpayer. Stop pampering people and hold EVERYONE accountable, but I fear that democrats want their base to be stupid and dependent on taxpayer handouts.

The problem is, you can't get kids to do well and stay in school if they are going to school with an ear infection or toothache or other untreated ailments. I get the point - that when you focus on getting them educated - you get them out of poverty and their opportunities to get better health care increase and thus so do their health outcomes. But kids need to also be in good health to succeed in school in the first place. So it's a circular argument.